Ebola: The Transformation of Redemption Hospital

Dominic W. Rennie is the general administrator of Redemption Hospital, which treats around 1,000 people per week in New Kru Town, Monrovia, Liberia. As the Ebola outbreak swept through Monrovia, the hospital found itself on the front lines: 12 of the staff died. A year later, their colleagues wear rubber boots and work in clean wards, renovated by organizations including the African Union (AU) and the International Rescue Committee (IRC).

Ebola Deeply: A year ago, Redemption Hospital was a very different place, transformed from a general hospital to an Ebola holding center. You’re now recovering from that period and basic health services have been restored. The hospital has since hosted an Ebola vaccine trial, and now a survivor study. How are things looking?

Rennie: Redemption Hospital was used as an Ebola holding center in September 2014, after a holding center in West Point was terminated. They asked us to host those patients that were at the center in West Point while the nearby Island Clinic was being prepared. We had to host Ebola patients for something like two months. During that period there were extreme sanitation measures including chlorination. Many of our floors were corroded because of the strength of the chlorine.

Redemption Hospital was highly hit. The first nurse that died from Ebola in this country, Esther Kesselly, died at Redemption Hospital. She was a staff nurse here. The first doctor that died from Ebola in this country was a Ugandan surgeon at Redemption Hospital. Then we had a physician’s assistant who also died, up to the number of 12 persons. It happened during the period when we had little assistance. In the beginning in May, June, July 2014 … that was when the Ebola virus was all around.

Our first renovations began in December 2014, at the time Ebola was subsiding. The African Union (AU) was the first to come in to help us renovate. We had other groups like the IRC and ICRC [International Committee of the Red Cross] that came in to help us with specific projects. The AU renovated the maternity ward and the medical ward. They also did some renovations in the outpatient department, and that helped significantly. We identified the way we wanted to go; we wanted to open incrementally, in phases, because we could not do it all at once. We had other problems like staffing and coordination, because what the Ebola virus did was to demoralize the whole system. It brought the system down.

Ebola Deeply: At that time you had a staffing and equipment crisis on your hands, as well as a health crisis. How did you manage?

Rennie: At the height of the outbreak, staff left our facility to go and fight the disease in Ebola treatment units (ETUs). But we needed people here to work in the hospital as we attempted to reinstate basic health services. The AU provided close to 40 staff – doctors, nurses and physician’s assistants. They were absolutely essential.

We had few materials to work with, although we had some training. We had personal protective equipment (PPE), but it came in kind of late and we had no experience of using it. You know, teaching is one thing but having the experience is another.

Ebola Deeply: Because Redemption Hospital was so badly hit at the start of the outbreak, a narrative of fear developed around it. It was dubbed ‘the Ebola hospital.’ As you began to restore basic health services, was it hard to encourage staff to return to work?

Rennie: It took time for staff to want to come back to work. We had to talk to them about returning. Sometimes we had to use stringent measures to get them back, because they were kind of like, not wanting to come back immediately. But their services were needed. We crossed from the urgent Ebola stage toward the restoration of normal services, and we didn’t want any breaks in that chain. Some staff who had gone to work in ETUs were feeling exhausted, and they felt that they should rest for a while; those came back.

Others that had gone to take up assignments in ETUs could not return, even though they would have liked to, because their assignments were not over. At the same time, they had commitments to the hospital. The AU was very instrumental in filling the gap that we had. They sent staff from different parts of Africa. There were not really many challenges of communication; all the countries they came from were English-speaking countries. We ensured that those staff also followed the “keep safe, keep serving” rule. For us, on the ground, we were the people with the experience. We advised them to never be slack. We said, “this is not a joke. You haven’t experienced anything yet.”

We had a psychosocial team that worked alongside staff at that time. They talked to them and helped them develop their morale. But essentially, some of the things that really made staff convinced were the new systems put into place to ensure that they were safe: the infection prevention and control (IPC) protocol, the renovations. Now we have an IPC team that regularly monitors things; we meet every week and examine some of our weaknesses, strengths, you know. Sometimes we had to give staff pep talks to appreciate them. It all added together to ensure that staff were motivated. But I think that while we’re speaking now, everybody’s on board and we are moving. We have close to 500 staff now.

Ebola Deeply: Recent renovations include new equipment, but new protocols too, such as reducing the number of beds because they must be 3 to 4 feet apart. What other kinds of challenges remain?

Rennie: What is required to operate the hospital has kind of doubled. Unlike before, you see, when it comes to IPC materials, it’s very expensive. You need to have them regularly. Our budget – we have a budget from government – cannot sustain every demand. This is a free service hospital. We have challenges in getting drugs and equipment. Everything is free, you just walk in, but the thing is, we don’t have all the drugs for all the conditions. So sometimes you come and the doctor will see you and recommend drugs that you can buy at the pharmacy. For the basic drugs, essential drugs, we try to make sure we get them, and we get them from the national drug service.

Ebola Deeply: The hospital seems quite busy today, and patients are being screened at the entrance before entering the main facility. Has it been hard to encourage patients in the catchment area to put their faith back in the hospital and return to seek basic health services?

Rennie: It was difficult. What we did, with our psychosocial team, was to get out to the community and explain to people why it was safe to come and seek treatment. One of the things that caused fright in them was the way our doctors and nurses dressed to give services. We had to explain to them. They would think, “Maybe I have Ebola. This must be why I’m being met by a doctor in PPE.” Coming to the hospital now is not like before. You have to be triaged. You have to answer questions before you enter into the main facility.

If staff think Ebola is a possibility, you are instead transferred to the transit unit, right across from here. They will further investigate you, take care of you, and ensure that you are given appropriate care. Fortunately, we have not had any more cases.